array:23 [
  "pii" => "S1695403300786310"
  "issn" => "16954033"
  "doi" => "10.1016/S1695-4033(00)78631-0"
  "estado" => "S300"
  "fechaPublicacion" => "2000-11-01"
  "aid" => "78631"
  "copyright" => "Asociación Española de Pediatría"
  "copyrightAnyo" => "2000"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "sco"
  "cita" => "An Pediatr (Barc). 2000;53:470-8"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 4567
    "formatos" => array:3 [
      "EPUB" => 68
      "HTML" => 4011
      "PDF" => 488
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1695403300786322"
    "issn" => "16954033"
    "doi" => "10.1016/S1695-4033(00)78632-2"
    "estado" => "S300"
    "fechaPublicacion" => "2000-11-01"
    "aid" => "78632"
    "copyright" => "Asociación Española de Pediatría"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "An Pediatr (Barc). 2000;53:479-81"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 6823
      "formatos" => array:3 [
        "EPUB" => 110
        "HTML" => 5947
        "PDF" => 766
      ]
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "titulo" => "Intoxicación oral accidental por mercurocromo"
      "tienePdf" => "es"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "es"
        1 => "en"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "479"
          "paginaFinal" => "481"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Accidental oral mercurochrome poisoning"
        ]
      ]
      "contieneResumen" => array:2 [
        "es" => true
        "en" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J. Ayala Curiel, C. Nieto Conde, C. Santana Rodríguez, A. Urbón Artero, R. Gracia Remiro"
          "autores" => array:5 [
            0 => array:2 [
              "nombre" => "J."
              "apellidos" => "Ayala Curiel"
            ]
            1 => array:2 [
              "nombre" => "C."
              "apellidos" => "Nieto Conde"
            ]
            2 => array:2 [
              "nombre" => "C."
              "apellidos" => "Santana Rodríguez"
            ]
            3 => array:2 [
              "nombre" => "A."
              "apellidos" => "Urbón Artero"
            ]
            4 => array:2 [
              "nombre" => "R."
              "apellidos" => "Gracia Remiro"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403300786322?idApp=UINPBA00005H"
    "url" => "/16954033/0000005300000005/v1_201307051525/S1695403300786322/v1_201307051525/es/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1695403300786309"
    "issn" => "16954033"
    "doi" => "10.1016/S1695-4033(00)78630-9"
    "estado" => "S300"
    "fechaPublicacion" => "2000-11-01"
    "aid" => "78630"
    "copyright" => "Asociación Española de Pediatría"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "sco"
    "cita" => "An Pediatr (Barc). 2000;53:469"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 4562
      "formatos" => array:3 [
        "EPUB" => 58
        "HTML" => 3762
        "PDF" => 742
      ]
    ]
    "es" => array:7 [
      "idiomaDefecto" => true
      "titulo" => "Virginia Apgar y su test posnatal medio siglo después"
      "tienePdf" => "es"
      "tieneTextoCompleto" => 0
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "469"
        ]
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J.S. Mazana Casanova"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "J.S."
              "apellidos" => "Mazana Casanova"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403300786309?idApp=UINPBA00005H"
    "url" => "/16954033/0000005300000005/v1_201307051525/S1695403300786309/v1_201307051525/es/main.assets"
  ]
  "es" => array:14 [
    "idiomaDefecto" => true
    "titulo" => "Estudio prospectivo sobre el empleo de catéteres umbilicales en el recién nacido"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "470"
        "paginaFinal" => "478"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "B. Fernández Colomer, A. Ramos Aparicio, J.B. López Sastre, G.D. Coto Cotallo"
        "autores" => array:5 [
          0 => array:3 [
            "nombre" => "B."
            "apellidos" => "Fernández Colomer"
            "email" => array:1 [
              0 => "gcastrillo@hca.es"
            ]
          ]
          1 => array:2 [
            "nombre" => "A."
            "apellidos" => "Ramos Aparicio"
          ]
          2 => array:2 [
            "nombre" => "J.B."
            "apellidos" => "López Sastre"
          ]
          3 => array:2 [
            "nombre" => "G.D."
            "apellidos" => "Coto Cotallo"
          ]
          4 => array:2 [
            "colaborador" => "Grupo de Hospitales Castrillo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:1 [
            "entidad" => "Hospital Central de Asturias&#46; Oviedo"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#42;"
            "correspondencia" => "<span class="elsevierStyleItalic">Correspondencia&#58;</span> Servicio de Neonatolog&#237;a&#46; Hospital Central de Asturias&#46; Celestino Villamil&#44; s&#47;n&#46; 33006 Oviedo&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "en" => array:1 [
        "titulo" => "Prospective evaluation of umbilical catheters in newborn infants&#46; the castrillo hospital group"
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2000-05-01"
    "fechaAceptado" => "2000-09-01"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec186477"
          "palabras" => array:7 [
            0 => "<span class="elsevierStyleItalic">Cat&#233;ter umbilical</span>"
            1 => "<span class="elsevierStyleItalic">Neonato</span>"
            2 => "<span class="elsevierStyleItalic">Factores de riesgo</span>"
            3 => "<span class="elsevierStyleItalic">Sepsis relacionada con cat&#233;ter</span>"
            4 => "<span class="elsevierStyleItalic">Staphylococcus epidermidis</span>"
            5 => "<span class="elsevierStyleItalic">Estudios prospectivos</span>"
            6 => "<span class="elsevierStyleItalic">An&#225;lisis multivariante</span>"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key words"
          "identificador" => "xpalclavsec186478"
          "palabras" => array:11 [
            0 => "<span class="elsevierStyleItalic">Catheterization</span>"
            1 => "<span class="elsevierStyleItalic">Umbilical arteries</span>"
            2 => "<span class="elsevierStyleItalic">Umbilical veins</span>"
            3 => "<span class="elsevierStyleItalic">Newborn infants</span>"
            4 => "<span class="elsevierStyleItalic">Risk factors</span>"
            5 => "<span class="elsevierStyleItalic">Sepsis</span>"
            6 => "<span class="elsevierStyleItalic">Staphylococcus epidermidis</span>"
            7 => "<span class="elsevierStyleItalic">Prospective studies</span>"
            8 => "<span class="elsevierStyleItalic">Multivariate analysis</span>"
            9 => "<span class="elsevierStyleItalic">Catheters</span>"
            10 => "<span class="elsevierStyleItalic">Indwelling</span>"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Conocer la situaci&#243;n actual en nuestro pa&#237;s sobre el empleo de cat&#233;teres umbilicales en reci&#233;n nacidos&#44; analizando caracter&#237;sticas t&#233;cnicas y complicaciones infecciosas&#44; mec&#225;nicas y locales&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Entre el 15 de julio de 1997 y el 31 de diciembre de 1998&#44; en los servicios de neonatolog&#237;a de los hospitales integrantes del Grupo de Hospitales Castrillo se estudiaron prospectivamente los cat&#233;teres umbilicales colocados en reci&#233;n nacidos&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se han estudiado 489 cat&#233;teres umbilicales &#40;201 venosos y 288 arteriales&#41; colocados en 475 reci&#233;n nacidos&#46; Se insertaron con facilidad&#44; permanecieron colocados por lo general menos de 5 d&#237;as y la mayor&#237;a se retiraron de forma electiva&#46; Se enviaron para estudio bacteriol&#243;gico 461puntas de cat&#233;ter &#40;94&#44;3 &#37;&#41; y en 98 &#40;21&#44;2 &#37;&#41; el cultivo result&#243; positivo&#59; 85 &#40;18&#44;4 &#37;&#41; se consideraron contaminados y 11 &#40;2&#44;4 &#37;&#41; con sepsis relacionada con cat&#233;ter &#40;SRC&#41;&#46; Staphylococcus epidermidis fue el germen aislado m&#225;s habitualmente &#40;72&#44;2 &#37; en contaminaci&#243;n y 63&#44;6 &#37; en SRC&#41;&#46; La permanencia del cat&#233;ter 3 d&#237;as o m&#225;s fue el principal factor de riesgo para la contaminaci&#243;n y para la SRC fueron la permanencia 3 d&#237;as o m&#225;s y el peso del reci&#233;n nacido menor o igual a 1&#46;500 g&#46; El 7&#44;9 &#37; de los cat&#233;teres venosos y el 9&#37; de los arteriales presentaron complicaciones locales&#59; la salida accidental fue la complicaci&#243;n m&#225;s habitual en los cat&#233;teres venosos &#40;3&#44;98 &#37;&#41; y alteraci&#243;n de perfusi&#243;n en extremidades en los arteriales &#40;2&#44;77 &#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusi&#243;n</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Los cat&#233;teres umbilicales en nuestra casu&#237;stica&#44; han tenido una baja incidencia de complicaciones&#46; Debe evitarse una permanencia prolongada y as&#237; los beneficios prevalecer&#225;n sobre los riesgos en estos cat&#233;teres&#46;</p>"
      ]
      "en" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate the current use of umbilical catheters in newborn infants in Spain by analyzing technical characteristics and infections&#44; as well as mechanical and local complications&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Umbilical catheters inserted in newborns in the neonatal units of the hospitals in the Castrillo Hospital Group from July 15&#44; 1998 to December 31&#44; 1998 were collected for prospective analysis&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 489 umbilical catheters &#40;201 venous and 288 arterial&#41; placed in 475 newborns were analysed&#46; No difficulties were found in inserting the catheters and they had an average indwelling time of less than 5 days&#46; Most were removed electively&#46; A total of 461 &#40;94&#46;3 &#37;&#41; catheter tips were sent for microbiological examination and cultures were positive in 98 &#40;21&#46;2 &#37;&#41;&#46; Of these&#44; catheter contamination was found in 85 &#40;18&#46;4&#37;&#41; and catheter-related sepsis was confirmed in 11 &#40;2&#46;4 &#37;&#41;&#46; Staphylococcus epidermidis was the most commonly isolated organism &#40;72&#46;2&#37; of contaminated catheters and 63&#46;6&#37; of catheterrelated sepsis&#41;&#46; The main risk factor for contamination was duration of catheterization &#36; 3 days and that for cather- related sepsis was duration of catheterization &#36; 3 days and birth weight &#35; 1500 g&#46; Local or mechanical complications were documented in 7&#46;9 &#37; of venous catheters and 9&#37; of arterial catheters&#46; The most common complications were accidental dislodgment in venous catheters &#40;3&#46;98&#37;&#41; and clinical vascular compromise in the lower extremities in arterial catheters &#40;2&#46;77 &#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In our experience&#44; the umbilical catheter had a low complication rate&#46; To ensure that the benefits of catheterization outweigh the risks&#44; prolonged use of these devices should be avoided&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliogr&#237;fia"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:38 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Erythroblastosis foetalis or haemolytic disease of the newborn"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46;K&#46; Diamond"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:4 [
                        "tituloSerie" => "Proc Rov Soc Med"
                        "fecha" => "1947"
                        "volumen" => "10"
                        "paginaInicial" => "546"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Catheterization of umbilical vessel in newborn infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;A&#46; Kitterman"
                            1 => "R&#46;H&#46; Phibbs"
                            2 => "W&#46;H&#46; Tooley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatr Clin North Am"
                        "fecha" => "1970"
                        "volumen" => "17"
                        "paginaInicial" => "895"
                        "paginaFinal" => "912"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4921383"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of infection associated with umbilical vein catheterization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Anagnostakis"
                            1 => "A&#46; Kamba"
                            2 => "V&#46; Petrochilouv"
                            3 => "A&#46; Arseni"
                            4 => "N&#46; Matsaniotis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1975"
                        "volumen" => "86"
                        "paginaInicial" => "759"
                        "paginaFinal" => "765"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1169293"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Factors associated with umbilical catheter-related sepsis in neonates"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46; Landers"
                            1 => "A&#46;A&#46; Moise"
                            2 => "J&#46;K&#46; Fraley"
                            3 => "E&#46; Smith"
                            4 => "C&#46;J&#46; Baker"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "AJDC"
                        "fecha" => "1991"
                        "volumen" => "145"
                        "paginaInicial" => "657"
                        "paginaFinal" => "680"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A semiquantitative culture method for identifying intravenous-catheter-related infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "D&#46;G&#46; Maki"
                            1 => "E&#46;W&#46; Carol"
                            2 => "H&#46;W&#46; Sarafin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM197706092962301"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1977"
                        "volumen" => "296"
                        "paginaInicial" => "1305"
                        "paginaFinal" => "1309"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/323710"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Cat&#233;teres invasivos en el reci&#233;n nacido"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "C&#46; S&#225;nchez"
                            1 => "X&#46; Carbonell"
                            2 => "M&#46;T&#46; Esqu&#233;"
                            3 => "M&#46; Barjau"
                            4 => "J&#46; Mingueza"
                            5 => "L&#46; Girald&#243;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "An Esp Pediatr"
                        "fecha" => "1999"
                        "volumen" => "51"
                        "paginaInicial" => "382"
                        "paginaFinal" => "388"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10690231"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Umbilical venous catheterizations&#58; audit by the study group for complications of perinatal care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "J&#46; Seguin"
                            1 => "M&#46;A&#46; Fletcher"
                            2 => "S&#46; Landers"
                            3 => "D&#46; Brown"
                            4 => "T&#46; Macpherson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2007-994540"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Perinatol"
                        "fecha" => "1994"
                        "volumen" => "11"
                        "paginaInicial" => "67"
                        "paginaFinal" => "70"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8155217"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Umbilical arterial catheter use&#58; report of an audit conducted by the study group for complications of perinatal care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46;A&#46; Fletcher"
                            1 => "D&#46; Brown"
                            2 => "S&#46; Landers"
                            3 => "J&#46; Seguin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1055/s-2007-994564"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am J Perinatol"
                        "fecha" => "1994"
                        "volumen" => "11"
                        "paginaInicial" => "94"
                        "paginaFinal" => "99"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8198665"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Utilisation de catheters veineux ombilicaux double voie en unite de soins intensifs n&#233;onatals"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Storme"
                            1 => "M&#46; Ouali"
                            2 => "P&#46;S&#46; Ganga-Zandzou"
                            3 => "S&#46; Klosowski"
                            4 => "T&#46; Rakza"
                            5 => "C&#46; Fassler"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Pediatr"
                        "fecha" => "1999"
                        "volumen" => "6"
                        "paginaInicial" => "386"
                        "paginaFinal" => "390"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10230477"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Catheterisme ombilical technique&#44; indications et resultants&#46; I Catheterisme veineux"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Couchard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Fran&#231; Ped"
                        "fecha" => "1970"
                        "volumen" => "27"
                        "paginaInicial" => "895"
                        "paginaFinal" => "904"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Catheterisme ombilical technique&#44; indications et resultants&#46; I Catheterisme arteriel"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "M&#46; Couchard"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Fran&#231; Ped"
                        "fecha" => "1970"
                        "volumen" => "27"
                        "paginaInicial" => "905"
                        "paginaFinal" => "916"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Umbilical artery catheterization in newborns&#46; I&#46; Thrombosis in relation to catheter type and position"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Wesstr&#246;m"
                            1 => "O&#46; Finnstr&#246;m"
                            2 => "G&#46; Stenport"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Paediatr Scand"
                        "fecha" => "1979"
                        "volumen" => "68"
                        "paginaInicial" => "575"
                        "paginaFinal" => "581"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/463541"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Umbilical vessel catheterization&#58; indications&#44; management&#44; and evaluation of the technique"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;R&#46; Symansky"
                            1 => "H&#46;A&#46; Fox"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1972"
                        "volumen" => "80"
                        "paginaInicial" => "820"
                        "paginaFinal" => "826"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5018391"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reduced thrombus formation with silicone elastomere &#40;silastic&#41; umbilical artery catheters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;J&#46; Boros"
                            1 => "T&#46;R&#46; Thompson"
                            2 => "J&#46;W&#46; Reynolds"
                            3 => "C&#46;W&#46; Jarvis"
                            4 => "H&#46;J&#46; Willians"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1975"
                        "volumen" => "56"
                        "paginaInicial" => "981"
                        "paginaFinal" => "986"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1196766"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Umbilical artery catheters in the newborn&#58; effects of catheter materials &#40;Cochrane Review&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46;J&#46; Barrington"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:1 [
                        "serieFecha" => "2000"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Intravenous access in newborn infants&#58; impact of extended umbical venous catheter use on requirement for peripheral venous lines"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;B&#46; Loisel"
                            1 => "M&#46;M&#46; Smith"
                            2 => "M&#46;G&#46; MacDonald"
                            3 => "G&#46;R&#46; Martin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Perinatol"
                        "fecha" => "1996"
                        "volumen" => "16"
                        "paginaInicial" => "461"
                        "paginaFinal" => "466"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8979185"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Advantages of dual-lumen umbilical vessel catheters versus single-lumen umbilical vessel catheters and additional peripheral intravenous catheters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46;G&#46; Ginsberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Perinatol"
                        "fecha" => "1997"
                        "volumen" => "17"
                        "paginaInicial" => "218"
                        "paginaFinal" => "220"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9210078"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Use of a triple-lumen catheter for umbilical venous access in the neonate"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "J&#46;M&#46; Pinheiro"
                            1 => "M&#46;A&#46; Fisher"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1992"
                        "volumen" => "120"
                        "paginaInicial" => "624"
                        "paginaFinal" => "626"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1552405"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk factors associated with umbilical vascular catheter-associated thrombosis in newborn infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "N&#46;Y&#46; Boo"
                            1 => "N&#46;C&#46; Wong"
                            2 => "S&#46;S&#46; Zulkifli"
                            3 => "M&#46;S&#46; Lye"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Paediatr Child Health"
                        "fecha" => "1999"
                        "volumen" => "35"
                        "paginaInicial" => "460"
                        "paginaFinal" => "465"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10571759"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thrombosis due to catheterisation in infants and children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46;J&#46; Wigger"
                            1 => "B&#46;R&#46; Bransilver"
                            2 => "W&#46;A&#46; Blanc"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1970"
                        "volumen" => "76"
                        "paginaInicial" => "1"
                        "paginaFinal" => "11"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4243482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Umbilical artery catheterisation&#58; Demostration of arterial thrombosis by aortography"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "W&#46;A&#46; Neal"
                            1 => "J&#46;W&#46; Reynolds"
                            2 => "C&#46;W&#46; Jarvis"
                            3 => "H&#46;J&#46; Willians"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1972"
                        "volumen" => "50"
                        "paginaInicial" => "6"
                        "paginaFinal" => "13"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5038111"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thrombotic complications of umbilical artery catheters&#58; A clinical and radiographic study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "B&#46;W&#46; Goetzman"
                            1 => "R&#46;C&#46; Stadalnik"
                            2 => "H&#46;G&#46; Bogren"
                            3 => "W&#46;J&#46; Blankenship"
                            4 => "R&#46;M&#46; Ikeda"
                            5 => "J&#46; Thayer"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1975"
                        "volumen" => "56"
                        "paginaInicial" => "374"
                        "paginaFinal" => "379"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1161393"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Thromboatheromatous complications of umbilical arterial catheterization in the newborn period&#46; Clinicopathological study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "J&#46;E&#46; Tyson"
                            1 => "D&#46;J&#46; de Sa"
                            2 => "S&#46; Moore"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "1976"
                        "volumen" => "51"
                        "paginaInicial" => "744"
                        "paginaFinal" => "754"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1008579"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of heparin infusates in umbilical arterial catheters on frequency of thrombotic complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "M&#46;J&#46; Horgan"
                            1 => "A&#46; Bartoletti"
                            2 => "S&#46; Polansky"
                            3 => "J&#46; Peters"
                            4 => "T&#46;J&#46; Manning"
                            5 => "B&#46;M&#46; Lamont"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1987"
                        "volumen" => "111"
                        "paginaInicial" => "774"
                        "paginaFinal" => "778"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3312553"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0125"
              "etiqueta" => "25&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Umbilical artery catheters in the newborn&#58; effects of position of the catheter tip &#40;Cochrane Review&#41;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46;J&#46; Barrington"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:1 [
                        "serieFecha" => "2000"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0130"
              "etiqueta" => "26&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Low positioning of umbilical-artery catheters increases associated complications in newborn infants"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "S&#46;T&#46; Mokrohisky"
                            1 => "R&#46;L&#46; Levine"
                            2 => "J&#46;D&#46; Blumhagen"
                            3 => "R&#46;L&#46; Wesenberg"
                            4 => "M&#46;A&#46; Simmons"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1056/NEJM197809142991101"
                      "Revista" => array:6 [
                        "tituloSerie" => "N Engl J Med"
                        "fecha" => "1978"
                        "volumen" => "299"
                        "paginaInicial" => "561"
                        "paginaFinal" => "564"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/683224"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0135"
              "etiqueta" => "27&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Umbilical arterial and venous catheters&#58; placement&#44; use&#44; and complications"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Green"
                            1 => "M&#46;D&#46; Yohannan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Neonatal Netw"
                        "fecha" => "1998"
                        "volumen" => "17"
                        "paginaInicial" => "23"
                        "paginaFinal" => "28"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9850193"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0140"
              "etiqueta" => "28&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Colonizaci&#243;n umbilical en reci&#233;n nacidos normales&#46; Estudio comparativo de cuatro m&#233;todos de antisepsia umbilical"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "J&#46; Perapoch"
                            1 => "S&#46; Salcedo"
                            2 => "A&#46; Gallart"
                            3 => "G&#46; Peguero"
                            4 => "M&#46; Casellas"
                            5 => "C&#46; Barroso"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "An Esp Pediatr"
                        "fecha" => "1993"
                        "volumen" => "39"
                        "paginaInicial" => "195"
                        "paginaFinal" => "198"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8291800"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0145"
              "etiqueta" => "29&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contamination of umbilical catheters in the newborn infant"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;N&#46; Krauss"
                            1 => "R&#46;F&#46; Albert"
                            2 => "M&#46;M&#46; Kannan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1970"
                        "volumen" => "77"
                        "paginaInicial" => "965"
                        "paginaFinal" => "969"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4992073"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0150"
              "etiqueta" => "30&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Risk of local and systemic infections associated with umbilical vein catheterization&#58; a prospective study in 86 newborn patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;C&#46; Balagtas"
                            1 => "C&#46;E&#46; Bell"
                            2 => "L&#46;D&#46; Edwards"
                            3 => "S&#46; Levin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1971"
                        "volumen" => "48"
                        "paginaInicial" => "359"
                        "paginaFinal" => "367"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5094336"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "31&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contamination of umbilical catheters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46;B&#46; Casalino"
                            1 => "P&#46;J&#46; Lipsitz"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1971"
                        "volumen" => "78"
                        "paginaInicial" => "1077"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/5577192"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "32&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Contamination of umbilical vessel catheters&#58; encouraging information"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "W&#46;F&#46; Powers"
                            1 => "W&#46;H&#46; Tooley"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Pediatrics"
                        "fecha" => "1972"
                        "volumen" => "49"
                        "paginaInicial" => "470"
                        "paginaFinal" => "471"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4622017"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "33&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Umbilical artery catheterization in newborns&#46; II&#46; Infections in relation to catheterization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "G&#46; Wesstr&#246;m"
                            1 => "O&#46; Finnstr&#246;m"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Acta Paediatr Scand"
                        "fecha" => "1979"
                        "volumen" => "68"
                        "paginaInicial" => "713"
                        "paginaFinal" => "718"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/393063"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "34&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prophylactic antibiotics in chronic umbilical artery catheterization in respiratory distress syndrome"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H&#46; Bard"
                            1 => "G&#46; Albert"
                            2 => "F&#46; Teasdale"
                            3 => "B&#46; Doray"
                            4 => "B&#46; Martineau"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "1973"
                        "volumen" => "48"
                        "paginaInicial" => "630"
                        "paginaFinal" => "635"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4783004"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            34 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "35&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prophylactic antibiotics in umbilical artery catheterization in the newborn"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "P&#46;K&#46;J&#46; Van Vliet"
                            1 => "J&#46;M&#46; Gupta"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "1973"
                        "volumen" => "48"
                        "paginaInicial" => "296"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21032490"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            35 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "36&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Semiquantitative cultures and routine tip cultures on umbilical catheters"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;D&#46; Adam"
                            1 => "L&#46;D&#46; Edwards"
                            2 => "C&#46;C&#46; Becker"
                            3 => "H&#46;M&#46; Shrom"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "1982"
                        "volumen" => "100"
                        "paginaInicial" => "123"
                        "paginaFinal" => "126"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7035632"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            36 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "37&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Bacteriemia in newborn infants following umbilical catheterization"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "A&#46;N&#46; Krauss"
                            1 => "T&#46;J&#46; Caliendo"
                            2 => "M&#46;M&#46; Kannan"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "N Y State J Med"
                        "fecha" => "1972"
                        "volumen" => "72"
                        "paginaInicial" => "1136"
                        "paginaFinal" => "1137"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/4503215"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            37 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "38&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Total parenteral alimentation via indwelling umbilical catheters in the newborn period"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46;T&#46; Hall"
                            1 => "P&#46;G&#46; Rhodes"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Dis Child"
                        "fecha" => "1976"
                        "volumen" => "51"
                        "paginaInicial" => "929"
                        "paginaFinal" => "934"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/827978"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "es"
  "url" => "/16954033/0000005300000005/v1_201307051525/S1695403300786310/v1_201307051525/es/main.assets"
  "Apartado" => array:4 [
    "identificador" => "14234"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Medicina fetal y neonatolog&#237;a"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/16954033/0000005300000005/v1_201307051525/S1695403300786310/v1_201307051525/es/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403300786310?idApp=UINPBA00005H"
]
Compartir
Información de la revista
Vol. 53. Núm. 5.
Páginas 470-478 (noviembre 2000)
Compartir
Compartir
Descargar PDF
Más opciones de artículo
Vol. 53. Núm. 5.
Páginas 470-478 (noviembre 2000)
Acceso a texto completo
Estudio prospectivo sobre el empleo de catéteres umbilicales en el recién nacido
Prospective evaluation of umbilical catheters in newborn infants. the castrillo hospital group
Visitas
8821
B. Fernández Colomer, A. Ramos Aparicio, J.B. López Sastre, G.D. Coto Cotallo, Grupo de Hospitales Castrillo *
Hospital Central de Asturias. Oviedo
Este artículo ha recibido
Información del artículo
Objetivo

Conocer la situación actual en nuestro país sobre el empleo de catéteres umbilicales en recién nacidos, analizando características técnicas y complicaciones infecciosas, mecánicas y locales.

Métodos

Entre el 15 de julio de 1997 y el 31 de diciembre de 1998, en los servicios de neonatología de los hospitales integrantes del Grupo de Hospitales Castrillo se estudiaron prospectivamente los catéteres umbilicales colocados en recién nacidos.

Resultados

Se han estudiado 489 catéteres umbilicales (201 venosos y 288 arteriales) colocados en 475 recién nacidos. Se insertaron con facilidad, permanecieron colocados por lo general menos de 5 días y la mayoría se retiraron de forma electiva. Se enviaron para estudio bacteriológico 461puntas de catéter (94,3 %) y en 98 (21,2 %) el cultivo resultó positivo; 85 (18,4 %) se consideraron contaminados y 11 (2,4 %) con sepsis relacionada con catéter (SRC). Staphylococcus epidermidis fue el germen aislado más habitualmente (72,2 % en contaminación y 63,6 % en SRC). La permanencia del catéter 3 días o más fue el principal factor de riesgo para la contaminación y para la SRC fueron la permanencia 3 días o más y el peso del recién nacido menor o igual a 1.500 g. El 7,9 % de los catéteres venosos y el 9% de los arteriales presentaron complicaciones locales; la salida accidental fue la complicación más habitual en los catéteres venosos (3,98 %) y alteración de perfusión en extremidades en los arteriales (2,77 %).

Conclusión

Los catéteres umbilicales en nuestra casuística, han tenido una baja incidencia de complicaciones. Debe evitarse una permanencia prolongada y así los beneficios prevalecerán sobre los riesgos en estos catéteres.

Palabras clave:
Catéter umbilical
Neonato
Factores de riesgo
Sepsis relacionada con catéter
Staphylococcus epidermidis
Estudios prospectivos
Análisis multivariante
Objective

To evaluate the current use of umbilical catheters in newborn infants in Spain by analyzing technical characteristics and infections, as well as mechanical and local complications.

Methods

Umbilical catheters inserted in newborns in the neonatal units of the hospitals in the Castrillo Hospital Group from July 15, 1998 to December 31, 1998 were collected for prospective analysis.

Results

A total of 489 umbilical catheters (201 venous and 288 arterial) placed in 475 newborns were analysed. No difficulties were found in inserting the catheters and they had an average indwelling time of less than 5 days. Most were removed electively. A total of 461 (94.3 %) catheter tips were sent for microbiological examination and cultures were positive in 98 (21.2 %). Of these, catheter contamination was found in 85 (18.4%) and catheter-related sepsis was confirmed in 11 (2.4 %). Staphylococcus epidermidis was the most commonly isolated organism (72.2% of contaminated catheters and 63.6% of catheterrelated sepsis). The main risk factor for contamination was duration of catheterization $ 3 days and that for cather- related sepsis was duration of catheterization $ 3 days and birth weight # 1500 g. Local or mechanical complications were documented in 7.9 % of venous catheters and 9% of arterial catheters. The most common complications were accidental dislodgment in venous catheters (3.98%) and clinical vascular compromise in the lower extremities in arterial catheters (2.77 %).

Conclusions

In our experience, the umbilical catheter had a low complication rate. To ensure that the benefits of catheterization outweigh the risks, prolonged use of these devices should be avoided.

Key words:
Catheterization
Umbilical arteries
Umbilical veins
Newborn infants
Risk factors
Sepsis
Staphylococcus epidermidis
Prospective studies
Multivariate analysis
Catheters
Indwelling
El Texto completo está disponible en PDF
Bibliogrífia
[1.]
L.K. Diamond.
Erythroblastosis foetalis or haemolytic disease of the newborn.
Proc Rov Soc Med, 10 (1947), pp. 546
[2.]
J.A. Kitterman, R.H. Phibbs, W.H. Tooley.
Catheterization of umbilical vessel in newborn infants.
Pediatr Clin North Am, 17 (1970), pp. 895-912
[3.]
D. Anagnostakis, A. Kamba, V. Petrochilouv, A. Arseni, N. Matsaniotis.
Risk of infection associated with umbilical vein catheterization.
J Pediatr, 86 (1975), pp. 759-765
[4.]
S. Landers, A.A. Moise, J.K. Fraley, E. Smith, C.J. Baker.
Factors associated with umbilical catheter-related sepsis in neonates.
AJDC, 145 (1991), pp. 657-680
[5.]
D.G. Maki, E.W. Carol, H.W. Sarafin.
A semiquantitative culture method for identifying intravenous-catheter-related infection.
N Engl J Med, 296 (1977), pp. 1305-1309
[6.]
C. Sánchez, X. Carbonell, M.T. Esqué, M. Barjau, J. Mingueza, L. Giraldó.
Catéteres invasivos en el recién nacido.
An Esp Pediatr, 51 (1999), pp. 382-388
[7.]
J. Seguin, M.A. Fletcher, S. Landers, D. Brown, T. Macpherson.
Umbilical venous catheterizations: audit by the study group for complications of perinatal care.
Am J Perinatol, 11 (1994), pp. 67-70
[8.]
M.A. Fletcher, D. Brown, S. Landers, J. Seguin.
Umbilical arterial catheter use: report of an audit conducted by the study group for complications of perinatal care.
Am J Perinatol, 11 (1994), pp. 94-99
[9.]
L. Storme, M. Ouali, P.S. Ganga-Zandzou, S. Klosowski, T. Rakza, C. Fassler, et al.
Utilisation de catheters veineux ombilicaux double voie en unite de soins intensifs néonatals.
Arch Pediatr, 6 (1999), pp. 386-390
[10.]
M. Couchard.
Catheterisme ombilical technique, indications et resultants. I Catheterisme veineux.
Arch Franç Ped, 27 (1970), pp. 895-904
[11.]
M. Couchard.
Catheterisme ombilical technique, indications et resultants. I Catheterisme arteriel.
Arch Franç Ped, 27 (1970), pp. 905-916
[12.]
G. Wesström, O. Finnström, G. Stenport.
Umbilical artery catheterization in newborns. I. Thrombosis in relation to catheter type and position.
Acta Paediatr Scand, 68 (1979), pp. 575-581
[13.]
M.R. Symansky, H.A. Fox.
Umbilical vessel catheterization: indications, management, and evaluation of the technique.
J Pediatr, 80 (1972), pp. 820-826
[14.]
S.J. Boros, T.R. Thompson, J.W. Reynolds, C.W. Jarvis, H.J. Willians.
Reduced thrombus formation with silicone elastomere (silastic) umbilical artery catheters.
Pediatrics, 56 (1975), pp. 981-986
[15.]
K.J. Barrington.
Umbilical artery catheters in the newborn: effects of catheter materials (Cochrane Review).
[16.]
D.B. Loisel, M.M. Smith, M.G. MacDonald, G.R. Martin.
Intravenous access in newborn infants: impact of extended umbical venous catheter use on requirement for peripheral venous lines.
J Perinatol, 16 (1996), pp. 461-466
[17.]
H.G. Ginsberg.
Advantages of dual-lumen umbilical vessel catheters versus single-lumen umbilical vessel catheters and additional peripheral intravenous catheters.
J Perinatol, 17 (1997), pp. 218-220
[18.]
J.M. Pinheiro, M.A. Fisher.
Use of a triple-lumen catheter for umbilical venous access in the neonate.
J Pediatr, 120 (1992), pp. 624-626
[19.]
N.Y. Boo, N.C. Wong, S.S. Zulkifli, M.S. Lye.
Risk factors associated with umbilical vascular catheter-associated thrombosis in newborn infants.
J Paediatr Child Health, 35 (1999), pp. 460-465
[20.]
H.J. Wigger, B.R. Bransilver, W.A. Blanc.
Thrombosis due to catheterisation in infants and children.
J Pediatr, 76 (1970), pp. 1-11
[21.]
W.A. Neal, J.W. Reynolds, C.W. Jarvis, H.J. Willians.
Umbilical artery catheterisation: Demostration of arterial thrombosis by aortography.
Pediatrics, 50 (1972), pp. 6-13
[22.]
B.W. Goetzman, R.C. Stadalnik, H.G. Bogren, W.J. Blankenship, R.M. Ikeda, J. Thayer.
Thrombotic complications of umbilical artery catheters: A clinical and radiographic study.
Pediatrics, 56 (1975), pp. 374-379
[23.]
J.E. Tyson, D.J. de Sa, S. Moore.
Thromboatheromatous complications of umbilical arterial catheterization in the newborn period. Clinicopathological study.
Arch Dis Child, 51 (1976), pp. 744-754
[24.]
M.J. Horgan, A. Bartoletti, S. Polansky, J. Peters, T.J. Manning, B.M. Lamont.
Effect of heparin infusates in umbilical arterial catheters on frequency of thrombotic complications.
J Pediatr, 111 (1987), pp. 774-778
[25.]
K.J. Barrington.
Umbilical artery catheters in the newborn: effects of position of the catheter tip (Cochrane Review).
[26.]
S.T. Mokrohisky, R.L. Levine, J.D. Blumhagen, R.L. Wesenberg, M.A. Simmons.
Low positioning of umbilical-artery catheters increases associated complications in newborn infants.
N Engl J Med, 299 (1978), pp. 561-564
[27.]
C. Green, M.D. Yohannan.
Umbilical arterial and venous catheters: placement, use, and complications.
Neonatal Netw, 17 (1998), pp. 23-28
[28.]
J. Perapoch, S. Salcedo, A. Gallart, G. Peguero, M. Casellas, C. Barroso, et al.
Colonización umbilical en recién nacidos normales. Estudio comparativo de cuatro métodos de antisepsia umbilical.
An Esp Pediatr, 39 (1993), pp. 195-198
[29.]
A.N. Krauss, R.F. Albert, M.M. Kannan.
Contamination of umbilical catheters in the newborn infant.
J Pediatr, 77 (1970), pp. 965-969
[30.]
R.C. Balagtas, C.E. Bell, L.D. Edwards, S. Levin.
Risk of local and systemic infections associated with umbilical vein catheterization: a prospective study in 86 newborn patients.
Pediatrics, 48 (1971), pp. 359-367
[31.]
M.B. Casalino, P.J. Lipsitz.
Contamination of umbilical catheters.
J Pediatr, 78 (1971), pp. 1077
[32.]
W.F. Powers, W.H. Tooley.
Contamination of umbilical vessel catheters: encouraging information.
Pediatrics, 49 (1972), pp. 470-471
[33.]
G. Wesström, O. Finnström.
Umbilical artery catheterization in newborns. II. Infections in relation to catheterization.
Acta Paediatr Scand, 68 (1979), pp. 713-718
[34.]
H. Bard, G. Albert, F. Teasdale, B. Doray, B. Martineau.
Prophylactic antibiotics in chronic umbilical artery catheterization in respiratory distress syndrome.
Arch Dis Child, 48 (1973), pp. 630-635
[35.]
P.K.J. Van Vliet, J.M. Gupta.
Prophylactic antibiotics in umbilical artery catheterization in the newborn.
Arch Dis Child, 48 (1973), pp. 296
[36.]
R.D. Adam, L.D. Edwards, C.C. Becker, H.M. Shrom.
Semiquantitative cultures and routine tip cultures on umbilical catheters.
J Pediatr, 100 (1982), pp. 123-126
[37.]
A.N. Krauss, T.J. Caliendo, M.M. Kannan.
Bacteriemia in newborn infants following umbilical catheterization.
N Y State J Med, 72 (1972), pp. 1136-1137
[38.]
R.T. Hall, P.G. Rhodes.
Total parenteral alimentation via indwelling umbilical catheters in the newborn period.
Arch Dis Child, 51 (1976), pp. 929-934
Copyright © 2000. Asociación Española de Pediatría
Descargar PDF
Idiomas
Anales de Pediatría
Opciones de artículo
Herramientas
es en

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?